[The mass screening for prostate cancer and the age eligibility. Gunma Urological Oncology Study Group].

BACKGROUND: The age eligibility for the mass screening (MS) for prostate cancer was investigated. METHODS AND MATERIALS: This study was performed in subjects examined by MS from 1981 to 1994 in Gunma Prefecture, Japan. MS was performed by digital rectal examination (DRE) and prostatic acid phosphatase from 1981 to 1991, and by DRE, transrectal ultrasonography and prostate specific antigen from 1992 to 1994. RESULTS: It was demonstrated that the prostate cancer detection rate was affected by the ratio of subjects newly and previously examined, the age distribution in the group examined and the diagnostic modality. It was also demonstrated that the detection rate of early stage prostate cancer was also affected by the age distribution and the diagnostic modality. The effective detection rate was determined on the assumption that the purpose of MS is the detection of the subjects who have the indication for the radical prostatectomy, and the effective detection rate was calculated in the range from 50 to 69 years for age eligibility, and B and C for clinical stage. It was estimated that effective detection rate was 0.37 to 0.61%. They were higher than the detection rate of MS for other organ cancers. CONCLUSION: The eligibility is 50 to 69 years. If subjects in the range of 70 to 74 are included in this project, it is necessary to make an effort practice a subject-education about the prostate cancer natural history and the radical prostatectomy indication.

[Clinical evaluation of Augpenin (clavulanic acid-ticarcillin) in urinary tract infections: especially against beta-lactamase producing strains].

Augpenin contains ticarcillin (TIPC) and clavulanic acid (CVA), at a ratio of 15:1. The beta-lactamase inhibitor, CVA, has been added to protect the TIPC from inactivation by beta-lactamase. To investigate the drug efficacy and safety against urinary tract infections (UTI), Augpenin was administered to 33 patients with chronic complicated UTI and 7 patients with acute pyelonephritis. Thirty two cases were evaluable by the UTI criteria. Excellent results were obtained in 6 of the cases of acute pyelonephritis, and moderate results in 1 case, with an overall effectiveness rate of 100%. Excellent results were obtained in 14 of the cases of chronic complicated UTI, moderate results in 9 cases, and poor results in 2 cases, with an overall effectiveness rate of 92%. No adverse reactions were noted, but a transient elevation of glutamic oxaloacetic transaminase and glutamic pyruvic transaminase levels was observed in 2 cases.

[Significance of prostatic specific antigen in the mass screening for prostate cancer].

The significance of prostatic specific antigen (PSA) was investigated in the subjects examined by the mass screening for prostate cancer from 1985 to 1990. All subjects was examined by digital rectal examination (DRE) and with prostatic acid phosphatase (PAP) and the subjects in whom prostate cancer (Pca) was suspected from abnormal DRE and/or elevated PAP were recommended to receive the secondary screening to confirm the presence of Pca. PSA was measured by radioimmunoassay using Ball-Elsa-PSA-kit. 1,600 serum samples were obtained from our serum bank. The relationship among PSA, prostate size estimated by DRE and age was investigated. PSA was increased with age and the prostate size, PSA being more closely related with the latter. Therefore, we estimated that PSA has an ability to detect benign prostatic hypertrophy (BPH) in the mass screening. This estimation should be confirmed by using an ultrasound tomography because the prostate size obtained by DRE is inaccurate as compared with that obtained by ultrasound tomography. The cut off level of PSA was determined by control which was composed from the subjects with normal size prostate and one with BPH. When the cut off level was 8.6 ng/ml, the sensitivity, specificity and efficiency as Pca marker was 73.9%, 97.4% and 97.1%, respectively. PSA was more than 8.6 ng/ml in all of Pca with elevated PAP. PSA was expected to improve the Pca detection rate in our mass screening system.

[Therapy of renal cell carcinoma. 3. Interferon therapy].

Human lymphoblastoid interferon (HLBI-alpha) or recombinant human leukocyte interferon (HLIF-alpha) was administered to ten patients suffering from renal cell carcinoma at a daily dose of 5 X 10(6) units. The efficacy of interferon was assessed in nine patients who had received HLBI-alpha or HLIF-alpha for more than eight weeks. One patient (11%) demonstrated complete response (CR), three patients (33%) showed no change and five patients (56%) continued to have progressive disease. CR was obtained after 30 weeks under HLBI-alpha and FT-207 combination therapy. The main side effects were fever, anorexia, general fatigue and hematologic toxicities. Cessation of interferon therapy due to side effects was necessary in three patients. In conclusion interferon is one of the most valuable agents in the treatment of renal cell carcinoma.

[Bilateral renal cell carcinoma: report of a case].

A case of asynchronous bilateral renal cell carcinoma is reported. The patient was a 71-year-old man who visited our clinic with complaints of asymptomatic macrohematuria and fever on November 20, 1960. Clinical diagnosis was left renal tumor and left nephrectomy was performed on December 4, 1960. Histological diagnosis was renal cell carcinoma (common type, clear cell subtype, alveolar type and G1). The postoperative course was uneventful until complaints of diarrhea and weight loss in November, 1983. He visited our clinic again with a right abdominal mass on January, 1984. Right renal selective angiography revealed an enlargement and abnormal vascularity with tumor stain, hypervascularity and pooling in the whole kidney except for the upper pole lesion. CT scan revealed a space occupying lesion. Right radical nephrectomy was performed on March 6, 1984. Histological diagnosis was renal cell carcinoma (common type, mixed subtype, alveolar and tubular type, G2). He was treated by hemodialysis and steroid therapy after right nephrectomy but he died of massive gastro-intestinal bleeding on April 22, 1984. The paper is the 15th report of a bilateral renal cell carcinoma in Japan.